Owen Tsung Wen Ho 1, Winston Cheng Ann Ng 1, Zachariah Gene Wing Ow 1, Yeung Jek Ho 1, Wen Hui Lim 1, Jie Ning Yong 1, Renaeta Shiqi Wang 1, Keng Lin Wong 1 2, Cheng Han Ng 1, Mark D Muthiah 1 3 4, Claire Min-Li Teo 5
Transpl Int. 2021 Apr 21.doi: 10.1111/tri.13887. .
Aim: To investigate the efficacy of bisphosphonates and compare oral and IV formulations on bone mineral density (BMD) and fracture incidence in post-orthotopic liver transplant (OLT) patients.
Methods: Electronic databases were searched, and six RCTs and three cohort studies were included out of 711 articles. Main outcomes included post-OLT BMD changes, fracture incidence, and treatment adverse reactions. Pairwise meta-analysis was conducted for binary and continuous outcomes, while pooled fracture incidence utilized single-arm meta-analysis.
Results: Post-OLT fracture incidence was reported in nine studies (n=591). Total fracture incidence was 6.6% (CI: 3.4% to 12.4%) in bisphosphonate group and 19.1% (CI: 14.3% to 25.1%) in calcium and vitamin D group. Total fractures were significantly lower in patients on bisphosphonate, compared to calcium and vitamin D (n = 591; OR = 0.037; CI: 0.18 to 0.77; p=0.008) Overall fractures were significantly lower in the oral group (n= 263; OR = 0.26; CI: 0.08 to 0.85, p=0.02) but not in the IV group (n = 328; OR = 0.45; CI: 0.16 to 1.26, p=0.129).
Conclusion: Both oral and IV bisphosphonates are effective in reducing fracture incidence post-OLT compared to calcium and vitamin D. Oral formulations may also have an advantage over IV in reducing bone loss and fracture incidence post-OLT.